未成熟粒细胞百分率在重症急性胰腺炎早期评估中的临床价值  

Clinical value of immature granulocyte percentage in early evaluation of severe acute pancreatitis

作　　者：侯伟 李连谦 武文龙 肖博文 HOU Wei;LI Lianqian;WU Wenlong;XIAO Bowen(Department of General Surgery,Pcmjin Central Hospital,Panjin,Liaoning 124010,China)

机构地区：[1]辽宁省盘锦市中心医院普通外科,辽宁盘锦124010

出　　处：《中国普通外科杂志》2020年第3期341-347,共7页China Journal of General Surgery

摘　　要：背景与目的:重症急性胰腺炎(SAP)是常见的急腹症,其进展快、并发症多、病死率高,而SAP的早期识别对指导临床治疗、改善患者预后有着重要意义。未成熟粒细胞百分率(IG%)是一种新兴的炎性指标,在疾病早期即可出现明显变化。鉴于炎性指标在SAP的发生发展中起着关键作用,本研究探讨IG%在SAP早期评估中的临床价值。方法:回顾性分析2010年1月-2019年10月期间521例根据指南确诊为急性胰腺炎(AP)的患者临床资料,其中63例为SAP(SAP组),458例轻症或中重症AP(非SAP组)。比较两组患者的临床特征、IG%、白细胞(WBC)计数、中性粒细胞与淋巴细胞比率(NLR)、C反应蛋白(CRP)、淀粉酶水平等指标,采用受试者工作特征曲线(ROC)分析各炎性指标对SAP的诊断效能。结果:SAP组的病死率为2.2%(18/63),非SAP组为28.6%(10/458);SAP组患者较非SAP组患者年龄偏大、ICU入住与行外科治疗比例高、住院时间长(均P<0.05)。SAP组IG%、WBC、NLR、CRP均明显高于非SAP组(均P<0.05),但两组血清淀粉酶水平无统计学差异(P=0.163)。ROC曲线分析结果显示,IG%、WBC、NLR、CRP对预测SAP的有效性均有统计学意义(均P<0.05);IG%在最佳临界值为0.9时的曲线下面积(AUC)为0.973,敏感度为100%,特异度为93.8%,明显优于WBC(AUC:0.665;敏感度:66.6%;特异度:87.6%)、NLR(AUC:0.752;敏感度:73.3%;特异度:76.5%)、CRP(AUC:0.802;敏感度:100%;特异度:54.9%)。结论:血常规中IG%>0.9可能是早期胰腺坏死的重要指标,与其他传统炎性指标相比,IG%可能是一种更有效、更可靠的SAP早期预测指标。Background and Aims:Severe acute pancreatitis(SAP)is a dangerous acute abdominal disorder,characterized by rapid progression,numerous complications and high mortality.Early detection of SAP may helpful for guiding the clinical treatment and improving the prognosis of the patients.Immature granulocyte percentage(IG%)is an emerging inflammatory indicator,which may display an obvious change in the early stage of diseases.Considering the inflammatory indicators play crucial roles in the development of SAP,this study was to conducted to evaluate the clinical value of IG%in the early detection of SAP.Methods:The clinical data of 521 patients diagnosed as acute pancreatitis(AP)according to the guidelines from January 2010 to October 2019 were retrospectively analyzed.Of the patients,63 cases were SAP(SAP group)and 458 cases were mild or moderately severe AP(non-SAP group).The clinical features and the variables that included IG%,white blood cell(WBC)count,neutrophil to lymphocyte ratio(NLR),C-reactive protein(CRP)and amylase level were compared between the two groups of patients.The diagnostic efficiency of each inflammatory indicator for SAP was determined by receiver operating characteristic curve(ROC)analysis.Results:The mortality rate in SAP group was 2.2%(18/63)and in non-SAP group was 28.6%(10/458);the patients was older,and the proportions of cases requiring ICU admission and surgical intervention were higher and the length of hospital stay was longer in SAP group than those in non-SAP group(all P<0.05).The levels of IG%,WBC,NLR and CRP in SAP group were significantly higher than those in non-SAP group(all P<0.005),but there was no significant difference in serum the amylase levels between the two groups(P=0.163).The results of ROC analysis showed that the diagnostic powers of IG%,WBC,NLR and CRP for SAP were all had significance(all P<0.005);the area under the curve(AUC)of IG%in predicting SAP was 0.973,with a sensitivity of 100%and specificity of 93.8%at the optimal cut-off value of 0.9,which was superior to WB

关 键 词：胰腺炎 急性坏死性/诊断 炎症 未成熟的粒细胞百分率 

分 类 号：R657.5[医药卫生—外科学]